scholarly journals P030 OPEN VERSUS LAPAROSCOPIC UMBILICAL AND EPIGASTRIC HERNIA REPAIR: NATIONWIDE DATA ON SHORT- AND LONG-TERM OUTCOMES

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Nadia Henriksen ◽  
Lars Nannestad Jorgensen ◽  
Hans Friis Andersen ◽  
Frederik Helgstrand
Keyword(s):  
Surgical Site Infection ◽  
Laparoscopic Repair ◽  
Open Repair ◽  
Reoperation Rate ◽  
Site Infection ◽  
Recurrence Rates ◽  
Severe Condition ◽  
Term Operation ◽  
Open Versus

Abstract Aim The aim of the study was to evaluate the rates of 90-day readmission and reoperation for complication, together with rate of operation for recurrence after either open or laparoscopic mesh repair for primary umbilical or epigastric hernias with defect widths above 1 cm. Material and Methods A merge of data between the Danish Hernia Database and the National Patient Registry provided data from 2007-2018 on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence Results A total of 6,855 patients were included, of whom 4,106 (59.9%) and 2,749 (40.1%) patients had an open or laparoscopic repair, respectively. There were significantly more patients readmitted with a superficial surgical site infection 2.5% (102/4,106) after open repair compared with laparoscopic repair (0.5% (15/2,749), P < 0.001. The 90-day reoperation rate for complications was significantly higher for open repairs 5.0% (205/4,106) compared with laparoscopic repairs 2.7% (75/2,749), P < 0.001. The incidence of a reoperation for a severe condition was significantly increased after laparoscopic repair 1.5% (41/2,749) compared with open repair 0.8% (34/4,106), P = 0.010. The 4-year cumulative incidence of operation for recurrence was 3.5% after open and 4.2% after laparoscopic repairs, P = 0.302. Conclusions Recurrence rates were comparable between open and laparoscopic repair of umbilical and epigastric hernias. Open repair was associated with a significantly higher rate of readmission and reoperation due to surgical site infection, whereas the rate of reoperation due to a severe complication was significantly higher after laparoscopic repair.

EP.TH.747Audit of antibiotic prophylaxis in groin hernia repair

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Maitreyi Patel ◽  
Aleem O'Balogun ◽  
Naveed Kirmani
Keyword(s):  
Hernia Repair ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Groin Hernia ◽  
Open Repair ◽  
Risk Category ◽  
Site Infection ◽  
Groin Hernia Repair ◽  
Hernia Surgery ◽  
International Guidelines

Abstract Aims To review practice of antibiotic prophylaxis in patients undergoing groin hernia repair against the International guidelines for groin hernia management 2018, in order to improve compliance with International Guidelines. We also assessed the risk category of patients. Methods Retrospective data of all patients undergoing groin hernia repair from November 2019 to March 2020 was collected using hospital software. Data collected included patient demographics, details of hernia repair including; primary/recurrent hernia, emergency/elective, laparoscopic/open repair and use of mesh. The details of antibiotic prophylaxis were recorded. Descriptive statistics was used. Data was analyzed using Microsoft Excel. Results 67 patients were included, of which 38(57%) were high risk. 62 (92.5%) primary repairs were done, of which 48(72%) were open. 62(92.5%) were operated electively. 46(69%) patients underwent open repair with mesh, 6(9%) had open repair without mesh, while 15(22%) had laparoscopic repair with mesh. A total of 45 (67%) patient received antibiotic prophylaxis. Adherence to International guidelines for groin hernia in open hernia surgery was 82.67%, while that for laparoscopic surgery was 60%. Overall adherence to the Guidelines was 56.67%. Conclusions The audit reflects the need for improved understanding and adherence to the International Guidelines. Data collection of surgical site infection can help inform and influence practice to minimize the risk for surgical site infection and assist in better communication with patients regarding risk. Risk assessment for surgical site infection of patients prior to procedure helps to identify those with indication of antibiotic prophylaxis.

scholarly journals Laparoscopic repair of umbilical and paraumbilical hernias: a prospective and interventional study in government hospital

2019 ◽  
Vol 6 (9) ◽  
pp. 3283
Author(s):  
Kiren B. Patel ◽  
Mithun V. Barot
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Wound Infection ◽  
Ventral Hernia ◽  
Laparoscopic Repair ◽  
Umbilical Hernia ◽  
Operative Time ◽  
Postoperative Hospital Stay ◽  
Site Infection ◽  
Drain Removal

Background: Umbilical and ventral hernia occurs as a result of weakness in musculofascial layer of anterior abdominal wall. The most important causes are congenital, acquired, incisional and traumatic. UH and VH can be repair by open surgical procedure. A successful series of laparoscopic repair of umbilical hernia and VH was done by Le blanc in 1993. The cost can be optimised by selection of mesh and optimal uses of transabdominal suture and various fixation devices. This original article reveals methods, techniques, indication, contraindication, post-op pain, operative time, surgical site infection recurrence and outcome of laparoscopic umbilical hernia and paraumbilical hernia repair.Methods: A total of 21 patients of ventral hernia (umbilical, paraumbilical and incisional), who underwent laparoscopic hernia repair from October 2014 to October 2016, were selected have taken part in study with valid consent, in B.J. Medical College Ahmedabad Gujarat. All patient study regarding operative time, postoperative pain, postoperative hospital stay, surgical site infection like wound infection, seroma, hernia defect size, mean drain removal and recurrence.Results: Out of 21 patients male are 33% and female are 67%. Mean age of patients is 45 yrs with range being 18-65 yrs. 28%, 33.33%, and 38.1% of patient had umbilical, paraumbilical and incisional hernia respectively. Mean size defect was 7.8 cm2. Mean operative time in this study is 98.6 minute. Mean drain removal is 2.80 day. Mean postoperative hospital stay was 3.3 days. 4.7% had wound infection, 9.5% had seroma formation. There is 0% recurrence in present study.Conclusions: The laparoscopic approach appears to be safe, effective and acceptable. It is also effective in those who are obese, with co morbidities (complex) and who have recurrence from prior open repair and having ascites.

Surgical site infection rates: open versus hand-assisted colorectal resections

2013 ◽  
Vol 18 (4) ◽  
pp. 381-386 ◽  
Author(s):  
M. Bishawi ◽  
M. Fakhoury ◽  
P. I. Denoya ◽  
S. Stein ◽  
R. Bergamaschi
Keyword(s):  
Surgical Site Infection ◽  
Site Infection ◽  
Infection Rates ◽  
Open Versus ◽  
Colorectal Resections

scholarly journals Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair

2014 ◽  
Vol 36 (3) ◽  
pp. 329-335 ◽  
Author(s):  
Margaret A. Olsen ◽  
Katelin B. Nickel ◽  
Anna E. Wallace ◽  
Daniel Mines ◽  
Victoria J. Fraser ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Surgical Site Infection ◽  
Ventral Hernia ◽  
Bowel Obstruction ◽  
Ventral Hernia Repair ◽  
International Classification Of Diseases ◽  
Site Infection ◽  
Anatomic Site ◽  
Incisional Ventral Hernia ◽  
Open Versus

ObjectiveTo investigate whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair.DesignRetrospective cohort study.PatientsCommercially insured enrollees aged 6 months-64 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural Terminology, fourth edition, codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from January 1, 2004, through December 31, 2010.MethodsSSIs within 90 days after hernia repair were identified by diagnosis codes. The χ2 and Fisher exact tests were used to compare SSI incidence by operative factors.ResultsA total of 119,973 hernia repair procedures were analyzed. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] vs 0.34% [57/16,524], P=.020) and incisional/ventral (4.20% [701/16,699] vs 2.03% [14/691], P=.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] vs 0.44% [247/55,720], P<.001) and umbilical (1.57% [131/8,355] vs 0.95% [157/16,562], P<.001), but not incisional/ventral hernia repair (4.01% [224/5,585] vs 4.16% [491/11,805], P=.645).ConclusionsThe incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Stratification of hernia repair SSI rates by some operative factors may facilitate accurate comparison of SSI rates between facilities.Infect Control Hosp Epidemiol 2014;00(0): 1–7

scholarly journals PERBANDINGAN ANTARA PEMBERIAN ANTIBIOTIKA PROFILAKSIS PADA SEKSIO SESAR SESUAI ALUR KLINIS RSUP DR SARDJITO DENGAN ANTIBIOTIKA DOSIS MULTIPEL TERHADAP KEJADIAN INFEKSI LUKA OPERASI

2016 ◽  
Vol 3 (2) ◽  
pp. 75
Author(s):  
Ardian Rahmansyah ◽  
Mohammad Hakimi ◽  
Rukmono Siswishanto
Keyword(s):  
Length Of Stay ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Clinical Pathway ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
Site Infection ◽  
Short Term

Background: Clinical pathway recommend the use of short-term prophylaxis antibiotics for cesarean section. Long-term antibiotics or multiple doses was found in clinical practice. There are differences in the mode of administration and the number of doses administered at sardjito hospital.Objective: To determine the effectiveness of short-term antibiotic prophylaxis in cesarean section appropriate to clinical pathway in the prevention of surgical site infection (ssi), the incidence of fever, dysuria events, length of stay.Method: The study used randomized clinical trial. The study subjects who underwent cesarean section and meet the inclusion and exclusion criteria in the period July 2013 to January 2014 divided into an intervention group (n = 52) who received ampicillin 2 gram pre and post-cesarean section, and a control group (n = 54) who received ampicillin 2 gram pre cesarean section and 1 gram every 8 hours for 6 times. Observed on days 3 and 10 post-cesarean section. The primary outcomes assessed were the incidence of surgical wound infection based on the criteria of surgical site infection from Centers for Disease Controland Prevention. Secondary outcomes assessed were the incidence of fever, dysuria events, length of stay. Homogeneity analysis were conducted on subject. Outcome analysis performed bivariate with t test and chi squared test.Results and Discussion : A total of 106 subjects can be analyzed. SSI events in the intervention group at day 3 was 3.8% (n = 52) and control group was 1.84% (n = 54) with p>0.05 RR 2.077 (95% CI 0.194 to 22.219). SSI on day 10 of 7.7% (n = 52) in the intervention group versus 9.3% (n = 54) in controls with p<0.05 RR 0.831 (CI 95%, 0.236 to 2.924). Fever events on day 3 by 5.8% in the intervention group versus 3.7% incontrols with p>0.05 RR 1.558 (95% CI 0.271 to 8.948) and on day 10 was 3.8% versus 3.7 % with p>0.05 RR 1.038 (95% CI 0.152 to 7.102). Dysuria not found on day 3 and but on 10 found 5.8% in the intervention group versus 11.1% with p>0.05 RR 0.519 (IK95% 0.137 to 1.968). Length of stay after cesarean section for 3.21 ± 0.412 days in the intervention group and 3.26 ± 0.442 days in the control group with p>0.05 (95% CI -0.213 - 0.117).Conclusion: There is no significant difference in the incidence of surgical wound infections, the incidence of fever, dysuria, length of stay between short-term prophylaxis antibiotics ampicillin appropriate to clinical pathway and long-term or multiple doses prophylaxis antibiotics. Short term antibiotics prophylaxis are more efficiently with the same effectiveness in preventing outcomes research.Keywords: prophylaxis antibiotics, ampicillin, short term regimen, long term regimen, cesarean section, surgical site infection. 

A Bleeding Uretero-Arterial Fistula: Open Repair After Unsuccessful Endovascular Treatment

2020 ◽  
pp. 153857442095396
Author(s):  
Karolis Tijunaitis ◽  
Valerija Mosenko ◽  
Tomas Baltrūnas
Keyword(s):  
Surgical Site Infection ◽  
Open Repair ◽  
Treatment Options ◽  
Abdominal Aortic Aneurysm Repair ◽  
High Morbidity ◽  
Site Infection ◽  
Vascular Surgeon ◽  
Multiple Treatment ◽  
The Right ◽  
Bifurcated Graft

Introduction: Uretero-arterial fistula (UAF) poses major challenges in management and diagnosis due to the rarity of this condition and associated high morbidity/mortality rates. Methods: We describe a case of a UAF associated with previous aorto-biiliac grafting, ureteric stenting and right nephrectomy because of chronic pielonephritis and complicated by surgical site infection. This case illustrates a very complex pathology, with a challenging diagnosis and multiple treatment options. Results: A 72 year-old woman was referred to Vilnius Vascular Unit for open UAF repair. The patient had a history of open abdominal aortic aneurysm repair using a bifurcated graft 25 years ago. The right ureter was injured during the operation and a rigid indwelling ureteric stent was inserted. Six months prior to referral, she underwent a right nephrectomy due to a chronic pyelonephritis, complicated by surgical site infection, which was still present at the time of admission. Initial CTA demonstrated bilateral iliac aneurysms, but no signs of UAF. A further CTA revealed a UAF between the right ureteral stump and the right common iliac artery (CIA) para-anastomotic aneurysm. After unsuccessful attempts to embolize the UAF using both coils and glue, the patient was referred to Vilnius Vascular Unit for open repair. Left axillo-bifemoral bypass reconstruction was performed followed by UAF repair and bifurcated graft explantation. Follow-up after 2 years showed no recurrence of haematuria, good function of the remaining kidney and patent axillo-bifemoral bypass with no signs of infection around the prosthetic aortic stump. Conclusions: Uretero-arterial fistula is a uncommon condition in everyday clinical practice. The rarity of this condition may lead to delayed or missed diagnosis which can result in life-threating consequences. A multidisciplinary approach involving urologists, vascular surgeon and radiologist are crucial to both the diagnosis and managment of this rare entity.

Immediate Titanium Cranioplasty After Debridement and Craniectomy for Postcraniotomy Surgical Site Infection

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons8-ons15 ◽  
Author(s):  
Varun R. Kshettry ◽  
Sara Hardy ◽  
Robert J. Weil ◽  
Lilyana Angelov ◽  
Gene H. Barnett
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Hospice Care ◽  
Recurrent Infection ◽  
Csf Leak ◽  
Preoperative Radiation ◽  
Site Infection ◽  
Titanium Mesh ◽  
Titanium Cranioplasty

Abstract BACKGROUND: For postcraniotomy surgical site infection (SSI) involving the bone, typical management involves craniectomy, debridement, and delayed cranioplasty. Disadvantages to delayed cranioplasty include cosmetic deformity, vulnerability of unprotected brain, and risks and costs associated with an additional operation. Many authors have attempted bone flap salvage by using various techniques. OBJECTIVE: We evaluate our experience with immediate titanium mesh cranioplasty at the time of craniectomy and debridement. METHODS: We retrospectively reviewed SSIs in patients that underwent craniotomy for treatment of a brain tumor. These patients were treated with craniectomy, debridement, and immediate titanium mesh cranioplasty followed by antibiotics. The primary outcome was recurrent infection. RESULTS: Twelve patients met the inclusion criteria. Risk factors for infection included preoperative radiation therapy (33%), prior craniotomy (33%), and postoperative CSF leak (25%). Median follow-up was 14 months. Ten (83%) patients had long-term resolution without recurrent infection. One patient required additional surgical debridement for persistent infection with successful placement of new titanium mesh. Another patient developed recurrent infection but opted for hospice care because of tumor progression. CONCLUSION: This series demonstrates the safety and feasibility of performing immediate titanium cranioplasty at the time of craniectomy and debridement in patients with postcraniotomy infections. This has been shown in patients with risk factors for poor wound healing. Immediate cranioplasty avoids the drawbacks, risks, and costs of delayed cranioplasty.

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